The 492nd case: recurrent thrombosis, thrombocytopenia
10.3760/cma.j.cn112138-20210222-00149
- VernacularTitle:第492例——反复血栓形成，血小板减低
- Author:
Chong WEI
1
;
Kunyu ZHENG
;
Jiayuan DAI
;
Huacong CAI
;
Tienan ZHU
;
Jiuliang ZHAO
;
Daobin ZHOU
;
Junling ZHUANG
Author Information
1. 中国医学科学院 北京协和医学院 北京协和医院血液内科,北京 100730
- Keywords:
Thrombophilia;
Thrombocytopenia;
Antiphospholipid syndrome
- From:
Chinese Journal of Internal Medicine
2022;61(2):239-242
- CountryChina
- Language:Chinese
-
Abstract:
A 43-year-old female patient was admitted with recurrent thrombosis for more than 2 years and thrombocytopenia for more than 1 year. Both arterial and venous thromboses developed especially at rare sites even during anticoagulation therapy such as cerebral venous sinus thrombosis. Antinuclear antibody, anti-ENA antibody and antiphospholipid antibody were all negative. Platelet count elevated to normal after high dose glucocorticoid and intravenous immunoglobulin (IVIG). Immune thrombocytopenia was suspected. When 4 grade thrombocytopenia recurred, intravenous heparin, rituximab 600 mg, IVIG and eltrombopag were administrated. After 3 weeks, thrombocytopenia did not improve, and new thrombosis developed instead. Screening of thrombophilia related genes revealed PROS1 gene heterozygous mutation and MTHFR TT genotype. Low amount of serum IgG κ monoclonal protein was detected. Heparin-induced thrombocytopenia was differentiated and excluded. Finally, serum negative antiphospholipid syndrome was considered the most likely diagnosis. Dexamethasone 20 mg/day × 4 days combined with sirolimus 2 mg/day was prescribed. The patient was discharged with low molecular weight heparin. At one month, her headache was greatly relieved. The platelet count raised to 20-30×10 9/L, and no new thrombosis or bleeding was reported.
